Patterns of Alcohol Consumption Among Individuals With Alcohol Use Disorder During the COVID-19 Pandemic and Lockdowns in Germany
Authors: Friederike Deeken, Markus Reichert, Hilmar Zech, Julia Wenzel, Friederike Wedemeyer, Alvaro Aguilera, Acelya Aslan, Patrick Bach, Nadja S. Bahr, Claudia Ebrahimi, Pascale C. Fischbach, Marvin Ganz, Maria Garbusow, Charlotte M. Großkopf, Marie Heigert, Angela Hentschel, Damian Karl, Patricia Pelz, Mathieu Pinger, Carlotta Riemerschmid, Annika Rosenthal, Johannes Steffen, Jens Strehle, Franziska Weiss, Gesine Wieder, Alfred Wieland, Judith Zaiser, Sina Zimmermann, Henrik Walter, Bernd Lenz, Lorenz Deserno, Michael N. Smolka, Shuyan Liu, Ulrich W. Ebner-Priemer, Andreas Heinz, Michael A. Rapp, Nina Romanczuk-Seiferth, Andreas Ströhle, Felix Bermpohl, Christine Heim, Anne Beck, Heike Tost, Tobias Banaschewski, Falk Kiefer, Andreas Meyer-Lindenberg, Christian Beste, Tanja Endraß, Stefan Kiebel, Clemens Kirschbaum, Michael Marxen, Wolfgang E. Nagel, Maximilian Pilhatsch, Ann-Kathrin Stock, Viktoria Arndt, Matthew Belanger, Hao Chen, Sasha Frölich, Filippo Ghin, Caroline Neumer, Sarah Schwöbel, Gabriela Gan, Kristina Schwarz, Stefanie Kunas, Heiner Stuke
Journal: JAMA Network Open (2022)

Alcohol consumption (AC) leads to death and disability worldwide. Ongoing discussions on potential negative effects of the COVID-19 pandemic on AC need to be informed by real-world evidence.To examine whether lockdown measures are associated with AC and consumption-related temporal and psychological within-person mechanisms.This quantitative, intensive, longitudinal cohort study recruited 1743 participants from 3 sites from February 20, 2020, to February 28, 2021. Data were provided before and within the second lockdown of the COVID-19 pandemic in Germany: before lockdown (October 2 to November 1, 2020); light lockdown (November 2 to December 15, 2020); and hard lockdown (December 16, 2020, to February 28, 2021).Daily ratings of AC (main outcome) captured during 3 lockdown phases (main variable) and temporal (weekends and holidays) and psychological (social isolation and drinking intention) correlates.Of the 1743 screened participants, 189 (119 [63.0%] male; median [IQR] age, 37 [27.5-52.0] years) with at least 2 alcohol use disorder (AUD) criteria according to the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) yet without the need for medically supervised alcohol withdrawal were included. These individuals provided 14 694 smartphone ratings from October 2020 through February 2021. Multilevel modeling revealed significantly higher AC (grams of alcohol per day) on weekend days vs weekdays (β = 11.39; 95% CI, 10.00-12.77; P < .001). Alcohol consumption was above the overall average on Christmas (β = 26.82; 95% CI, 21.87-31.77; P < .001) and New Year's Eve (β = 66.88; 95% CI, 59.22-74.54; P < .001). During the hard lockdown, perceived social isolation was significantly higher (β = 0.12; 95% CI, 0.06-0.15; P < .001), but AC was significantly lower (β = -5.45; 95% CI, -8.00 to -2.90; P = .001). Independent of lockdown, intention to drink less alcohol was associated with lower AC (β = -11.10; 95% CI, -13.63 to -8.58; P < .001). Notably, differences in AC between weekend and weekdays decreased both during the hard lockdown (β = -6.14; 95% CI, -9.96 to -2.31; P = .002) and in participants with severe AUD (β = -6.26; 95% CI, -10.18 to -2.34; P = .002).This 5-month cohort study found no immediate negative associations of lockdown measures with overall AC. Rather, weekend-weekday and holiday AC patterns exceeded lockdown effects. Differences in AC between weekend days and weekdays evinced that weekend drinking cycles decreased as a function of AUD severity and lockdown measures, indicating a potential mechanism of losing and regaining control. This finding suggests that temporal patterns and drinking intention constitute promising targets for prevention and intervention, even in high-risk individuals.